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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 4  |  Page : 165-167

Incidence of colorectal cancer in North-Western India over 5 Years


1 Senior Resident, Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
2 Resident, Department of Radiation Oncology, ATRCTRI, Bikaner, Rajasthan, India
3 Assistant Professor, Department of Community Medicine, American International Institute of Medical Science, Udaipur, Rajasthan, India
4 Medical Officer, Department of Oncology, Government Mahatma Gandhi District Hospital, Banswara, Rajasthan, India

Date of Submission01-Sep-2021
Date of Acceptance22-Sep-2021
Date of Web Publication09-Dec-2021

Correspondence Address:
Dr. Naresh Kumar Khatri
Medical Officer, Department of Oncology, Government Mahatma Gandhi District Hospital, Banswara, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrcr.jrcr_29_21

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  Abstract 


Background: Colorectal cancer (CRC) is the most common gastrointestinal malignancy. CRC occurs more common in males than females worldwide. There are very few studies on the incidence of CRC in the state of Rajasthan. The present study evaluates its temporal variation and area-wise distribution. Materials and Methods: Five-year retrospective data on CRC incidence were obtained from Hospital-Based Cancer Registry of Regional Cancer Center (RCC), Bikaner, from January 2016 to December 2020. The collected data show the trend of CRC incidence over these 5 years. District- and tehsil-wise distribution of patients was also analyzed. Results: A total of 37,132 cases registered at RCC, Bikaner, from January 2016 to December 2020, there were 796 cases of CRC accounting for 2.14% of the total. Among these, there were 500 male and 296 female cases, respectively. The median age at the diagnosis of CRC was 53 years in females and 56 years in males. This 5-year data analysis showed an increasing trend of CRC incidence in the last 5 years. The highest incidence rate was found in the districts of Bikaner, Sri Ganganagar, Hanumangarh, and Churu, with most patients coming from Bikaner tehsil of Bikaner district. Conclusion: CRC cases have shown an increasing trend in the past 5 years in Rajasthan with a higher incidence in the North-western districts. There is a need to early diagnosis through screening and find out solutions for reducing the risk of CRC in future.

Keywords: Bikaner, colorectal cancer, incidence, Rajasthan, trend


How to cite this article:
Daga P, Rawal T, Gupta PK, Khatri NK. Incidence of colorectal cancer in North-Western India over 5 Years. J Radiat Cancer Res 2021;12:165-7

How to cite this URL:
Daga P, Rawal T, Gupta PK, Khatri NK. Incidence of colorectal cancer in North-Western India over 5 Years. J Radiat Cancer Res [serial online] 2021 [cited 2022 Jun 26];12:165-7. Available from: https://www.journalrcr.org/text.asp?2021/12/4/165/332107




  Introduction Top


Colorectal cancer (CRC) is the most common gatrointestinal tract malignancy worldwide, with the highest incidence rates being found in Eastern Asia and Central-Eastern Europe countries. compared to Western countries, the incidence rate of CRC is low in India. According to Globocon 2020 data, India is a single country, which contributing to 6.86% of the global cancer burden. Colon and rectal cancers were the 4th and 7th most common cancers in the world, 13th and 16th most common cancer in India by the incidence, respectively. Colon and rectal cancers were the 5th and 10th most common causes of cancer-related deaths in the world and 13th and 15th most common causes of cancer-related deaths in India, respectively. In India, deaths due to CRC were 35,385 in 2020, which were 4.15% of total cancer deaths.[1] In histology, more than 90% of CRCs are adenocarcinomas, whereas other histologic types include squamous cell carcinoma, melanoma, small cell carcinoma, carcinoid, sarcoma, and lymphoma.[2] The global CRC incidence is approximately 1.2/1,000,000 with about 600,000 deaths.[3] In India, CRC is the most common gastrointestinal malignancy in both genders, but in males, it carry more risk and also more common.

Age is a major risk factor for the development of CRC, with the median age of diagnosis in the seventh decade. The incidence rates increase dramatically between the age group of 40 and 50 years and each subsequent decade thereafter.[4] The most common location of CRC is the left side of the colon including the rectum.[5] CRC often produces minimal or no symptoms, but in symptomatic CRC patient, most common signs and symptoms are abdominal pain, change in bowel habits, hematochezia/melena, weakness, iron-deficiency anemia, and weight loss.[6],[7]

The present study evaluates the temporal variation of CRC incidence over a period of 5 years (2016–2020) and its district- and tehsil-wise distribution in Rajasthan.


  Materials and Methods Top


It was a single-center, retrospective study which involved 5 years' data of CRC incidence from Hospital-Based Cancer Registry (HBCR) of Regional Cancer Center (RCC), Bikaner, India, from January 2016 to December 2020. Being a retrospective study, no ethical approval required for the study as all patients was treated with the standard departmental protocol.

Patients included in the study were those who were diagnosed with CRC above the age of 15 years irrespective of the stage and histology. Patients from outside the state of Rajasthan or patients with second malignancies were excluded from the study. A total of 803 CRC cases were collected. The district-wise distribution of CRC was also mapped.


  Results Top


CRC contributed 2.14% of total cancer cases (n = 37,132) registered at RCC, Bikaner, from January 2016 to December 2020. In the last 5 years, 796 CRC cases, with a male (n = 500) to female (n = 296) ratio of 1.69:1 were registered [Table 1]. In our study, the highest incidence was found in the sixth and seventh decades and fifth and sixth decades in males and females, respectively [Table 2]. Most common histology was adenocarcinoma followed by squamous cell carcinoma [Table 3]. The area-wise distribution showed a high incidence rate in the districts of Bikaner and Sri Ganganagar [Figure 1], among which the maximum cases were reported from Bikaner tehsil of Bikaner district [Table 4].
Figure 1: Area-wise distribution of colorectal cancer patients in Rajasthan

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Table 1: Year- and gender-wise distribution of colorectal cancer patients in Rajasthan year number of patients

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Table 2: Age-wise distribution of colorectal cancer patients in Rajasthan

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Table 3: Histology-wise distribution of colorectal cancer in Rajasthan

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Table 4: Tehsil-wise distribution of colorectal cancer patients in Bikaner district

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  Discussion Top


CRC is the most common gastrointestinal tract malignancy worldwide. Compared to Western countries, the incidence rate of CRC are low in India. The incidence of CRC was relatively less among the younger population (<30 years) than the older age group population. The median age at the diagnosis of CRC was 56 years and 53 years in males and females, respectively. Data showed an increasing trend of CRC incidence over 5 years [Table 1].

Various risk factors in the pathogenesis of CRC, among them genetic, lifestyle, and environmental factors increases risk. A number of hereditary syndromes, including familial adenomatous polyposis, MUTYH-associated polyposis, and hereditary nonpolyposis colorectal cancer. Other factors including, increasing age, male gender, inflammatory bowel disease, increase body mass index, consumption of processed meat, refined grains, excessive alcohol intake, and smoking.[8],[9],[10] Neoplastic polyps, including tubular adenomas, villous adenomas, and tubulovillous adenomas, are precursors of colon cancers.[2],[11] Removing these polyps early, before they become malignant, is effective way of preventing CRC.[12] Evidence supports that screening of asymptomatic, average-risk individuals can detect CRC at early, curable stage, thereby reducing CRC mortality, and CRC more suitable for population screening than any other malignancy owing to a combination of factors.[13],[14],[15]

A study by Thomas et al. showed that the incidence rate of CRC in India increased in the last two decades. Even though absolute rates are low in the Indian population, but rising in the incidence rates cause problem in rising cancer morbidity. Hence, there is a need for cost-effective strategies to enable the early diagnosis for CRC in India, it will help in the treatment and increase survival rates of CRCs.[16]

Limitation

Data in the present study have been obtained from a HBCR of RCC, Bikaner, and might not represent the exact area-wise distribution of CRC cases in the state.


  Conclusion Top


CRC is one of the leading causes of cancer-related deaths in males in India. CRC cases have shown an increasing trend in the past 5 years in the state of Rajasthan. High incidence is seen in the north-western districts. There is a need to identify, analyze, and control risk factors for reducing the incidence of CRC in Rajasthan.

Acknowledgments

The authors would like to thank the doctors and support staff of the Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Globocan; 2020. Available from: http://globocan.iarc.fr/Default.aspx. [Last accessed on 05 Jul 2021].  Back to cited text no. 1
    
2.
Czito BW. Colon cancer. In: Tepper GA, editor. Clinical Radiation Oncology. Edinburgh, UK: Churchill Livingstone; 2007. p. 1101-11.  Back to cited text no. 2
    
3.
Heinrich S, Pestalozzi B, Lesurtel M, Berrevoet F, Laurent S, Delpero JR, et al. Adjuvant gemcitabine versus NEOadjuvant gemcitabine/oxaliplatin plus adjuvant gemcitabine in resectable pancreatic cancer: A randomized multicenter phase III study (NEOPAC study). BMC Cancer 2011;11:346.  Back to cited text no. 3
    
4.
Data from Surveillance, Epidemiology, and End Results Program. Available from: http://www.seer.cancer.gov. [Last accessed on 05 Jul 2021].  Back to cited text no. 4
    
5.
Mohandas KM, Desai DC. Epidemiology of digestive tract cancers in India. V. Large and small bowel. Indian J Gastroenterol 1999;18:118-21.  Back to cited text no. 5
    
6.
Speights VO, Johnson MW, Stoltenberg PH, Rappaport ES, Helbert B, Riggs M. Colorectal cancer: Current trends in initial clinical manifestations. South Med J 1991;84:575-8.  Back to cited text no. 6
    
7.
Steinberg SM, Barkin JS, Kaplan RS, Stablein DM. Prognostic indicators of colon tumors. The gastrointestinal tumor study group experience. Cancer 1986;57:1866-70.  Back to cited text no. 7
    
8.
Chan AT, Giovannucci EL. Primary prevention of colorectal cancer. Gastroenterology 2010;138:2029-43.e10.  Back to cited text no. 8
    
9.
Ekbom A, Helmick C, Zack M, Adami HO. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med 1990;323:1228-33.  Back to cited text no. 9
    
10.
Wei EK, Giovannucci E, Wu K, Rosner B, Fuchs CS, Willett WC, et al. Comparison of risk factors for colon and rectal cancer. Int J Cancer 2004;108:433-42.  Back to cited text no. 10
    
11.
Beets-Tan RG, Beets GL, Vliegen RF, Kessels AG, Van Boven H, De Bruine A, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 2001;357:497-504.  Back to cited text no. 11
    
12.
Goh KL. Changing trends in gastrointestinal disease in the Asia-Pacific region. J Dig Dis 2007;8:179-85.  Back to cited text no. 12
    
13.
U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med 2008;149:627-37.  Back to cited text no. 13
    
14.
Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008;58:130-60.  Back to cited text no. 14
    
15.
Kuipers EJ, Rösch T, Bretthauer M. Colorectal cancer screening – Optimizing current strategies and new directions. Nat Rev Clin Oncol 2013;10:130-42.  Back to cited text no. 15
    
16.
Thomas VM, Baby B, Wang K, Lei F, Chen Q, Huang B, et al. Trends in colorectal cancer incidence in India. J Clin Oncol 2020;38 Suppl 15:e16084.  Back to cited text no. 16
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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